Edited Version of February 14, 2001 Transcript
EIIP Virtual Library Presentation

"Public Health Preparedness for Bioterrorism"

Kim McCoy
Centers for Disease Control (CDC)

Amy Sebring
EIIP Technical Projects Coordinator

The original unedited transcript of the February 14, 2001 online Virtual Library presentation is available in the EIIP Virtual Library Archives (http://www.emforum.org/vlibrary/livechat.htm). The following version of the transcript has been edited for easier reading and comprehension. Typos were corrected, date/time/names attributed by the software to each input were deleted but the content of questions and responses are as stated by each participant. Answers to participants’ questions are grouped beneath the appropriate question to facilitate meaning.

[Opening / Introduction]

Amy Sebring: Welcome to the EIIP Virtual Library! Today we are featuring the Centers for Disease Control and Prevention (CDC) and their mandate in the area of bioterrorism, in a session entitled "Public Health Preparedness for Bioterrorism."

Now I am pleased to introduce Kim McCoy, who is a Program Analyst in the Management and Operations Section of the Bioterrorism Preparedness and Response Program at CDC. This is the office charged with enhancing CDC's capacities to assist States and other partners in responding to bioterrorism. Welcome Kim, and thank you for taking time to join us today. The floor is yours.


Kim McCoy: Thanks, Amy. Good afternoon and thank you for being here today to discuss the public health implications of bioterrorism. I look forward to hearing your comments and questions.

In 1998 the U.S. Department of Health and Human Services directed the Centers for Disease Control and Prevention (CDC) to lead the national effort to prepare public health and health care systems to respond to the threat of biological and chemical terrorism. This multi-faceted and complex effort was initiated via the establishment of the Bioterrorism Preparedness and Response Program (BPRP) at CDC in January 1999. Though BPRP is housed within the National Center for Infectious Diseases, the overall effort is conducted in partnership with the National Center for Environmental Health, the Epidemiology Program Office, the Public Health Practice Program Office, and the Office of Health and Safety.

Before I provide more detailed information about the national public health initiative to prepare for bioterrorism, I think it may be helpful to describe the threat and potential implications of bioterrorism. Bioterrorism generally refers to the use of a biological agent or chemical to intentionally cause illness or injury in a population. Recent examples of bioterrorism include the sarin gas attack in the Tokyo subway and the dispersal of Salmonella in salad bars by a religious group in The Dalles, Oregon.

Bioterrorism can be perpetrated through a variety of mechanisms including aerosol, food, water, or vectors. It can be announced, overt, or covert depending on the agent used and the intent of the terrorist. Attacks with a chemical agent tend to be overt because the impact of chemicals is more immediate and obvious. Biological terrorism is more likely to be covert in that the resulting illness may not become evident until days or weeks after the initial exposure.

One of the first steps in developing national capacity for response to bioterrorism was to identify the agents that pose the greatest risk to national security and public health.

The primary biologic agents of concern are those that 1) can be easily disseminated or transmitted from person to person, 2) cause high mortality, and 3) require special action for public health preparedness. They include Smallpox, Anthrax, Plague, Botulism, Tularemia, and Viral Hemorrhagic Fevers.

The primary chemical agents of concern are those that 1) are already known to be used as weapons, 2) are available to terrorists, 3) cause major morbidity or mortality, and 4) require special action for public health preparedness. They include nerve agents, blister agents, pesticides, dioxins and a variety of other chemicals.

CDC's strategic plan for developing national public health capacity to respond to bioterrorism is focused on the following elements: 1) preparedness and prevention, 2) detection and surveillance, 3) laboratory diagnosis and characterization, 4) response, 5) communication, and 6) training.

Preparedness and prevention efforts include activities such as development of response plans, implementation and testing of notification protocols, coordination of partners, assessment of current capacity, and applied research.

Detection and surveillance involves development and strengthening of methods, tools, and procedures for identification and investigation of unusual clusters of disease, syndromes, or injuries that may be indicative of bioterrorism.

Laboratory diagnosis and characterization of agents is done in stages via a network of clinical and public health laboratories at local, state, and federal levels. The goal of this activity is to ensure rapid, accurate diagnosis and reporting of potential biologic and chemical threat agents.

CDC, in collaboration with the Association of Public Health Laboratories, has established the National Laboratory Response Network that provides member laboratories across the nation with access to reagents, protocols, and technology for diagnosis of biologic agents. Response activities are focused on development of procedures for medical treatment and prophylaxis of infected persons and initiation of disease prevention or environmental decontamination measures.

To assist with response efforts, CDC has established the National Pharmaceutical Stockpile, a cache of pharmaceuticals, medical supplies and equipment that may be delivered to the site of an incident in the continental U.S. within 12 hours of the decision to deploy.

Finally, in the area of communications, CDC is working to upgrade information technology and systems throughout the country to facilitate rapid exchange of data and emergency information among public health, emergency response, law enforcement, public safety personnel and others.

The Health Alert Network is a communications tool, established by CDC at the local level, to serve as a platform for distribution of emergency alerts and information, distance learning, national disease surveillance, and electronic laboratory reporting. Benefits of the Health Alert Network include high-speed, secure Internet connections for local health officials; access to on-line, Internet- and satellite-based distance learning systems; and early warning broadcast alert systems.

Training is an underpinning of each element of preparedness for bioterrorism. CDC recently developed a National Bioterrorism Training Plan that will be implemented in phases over the next several years to ensure that public health officials are knowledgeable of and proficient in the relevant aspects of bioterrorism preparedness and response.

Each of the elements I just described is being addressed at the state and local level as well as at CDC. A primary component of CDC's Bioterrorism Preparedness and Response Initiative is a cooperative agreement program that provides funding and technical assistance to public health officials nationwide. All 50 states, the 4 largest metropolitan areas, and 1 U.S. territory receive funding to build or enhance public health capacity for response to bioterrorism.

Funding is provided for one or more of the following focus areas: 1) Preparedness Planning, 2) Epidemiology and Surveillance Capacity; 3) Laboratory Capacity for Biologic Agents, 4) Laboratory Capacity for Chemical Agents, and 5) Health Alert Network.

In addition to State, local and territorial health departments, CDC works with a broad range of partners to ensure a coordinated and comprehensive response to bioterrorism.

Federal partners include agencies such as the FBI, which will be responsible for crisis management, and FEMA, which will be responsible for consequence management, in the event of a bioterrorist attack.

We also work closely with the Departments of Defense, Justice, and Agriculture, and the Food and Drug Administration. Other partners include professional associations such as the National Association of City and County Health Officials and the Association of State and Territorial Health Officers, academic institutions such as Johns Hopkins University and St. Louis University, and a variety of public, private, and non-profit organizations.

Recent terrorist threats to the U.S. civilian population have highlighted the need for increased public health capacity to respond to bioterrorism. Public health efforts that are being implemented across the nation will serve the dual purpose of preparing the nation for the threat of bioterrorism as well as shoring up the nation's ability to respond to infectious disease outbreaks and other public health emergencies.

Again, thank you for being here today. I would be happy to respond to any questions that you have.

[Audience Questions & Answers]

Amy Sebring: Thank you, Kim. Audience please enter a question mark (?) to indicate you wish to be recognized; go ahead and compose your comment or question, but wait for recognition before hitting the enter key or clicking on Send. We now invite your questions/comments.


Elaine Sudanowicz: Do you find any relationship between bioterrorism and an outbreak of pandemic flu?

Kim McCoy: I'm not sure exactly what you mean by "relationship" but certainly there is overlap between the activities. Many of the activities that we implement for bioterrorism preparedness are similar to those that are conducted in preparation for pandemic influenza and other infectious disease outbreaks.


Greg Banner: I have a consolidated list of web sites for WMD and bioterrorism. Anyone who wants it can email <[email protected]>.


Mark DeMier: Regarding the National Bioterrorism Training Plan, does CDC partner with Noble Training Center and/or DoJ's Center for Domestic Preparedness? If so, do you coordinate how CDC and DoJ assist state and local agencies financially?

Kim McCoy: CDC does partner with DOJ and other federal partners but as you can imagine, federal coordination can be difficult. The Noble Training Center project is coordinated by OEP. OEP is the federal Office of Emergency Preparedness and they coordinate activities related to the medical response to bioterrorism. While we work with other federal agencies, funding is usually not coordinated; rather, we try to coordinate activities and implement complementary programs.


Jacqueline Cattani: What is the CDC's role with the US Department of Energy?

Kim McCoy: CDC does coordinate with DOE but not extensively.


Tom Quail: I know the major cities are currently going through domestic preparedness training? Do you know how many of these cities, EMS and Fire Services, have completed the training?

Kim McCoy: Tom, if you're talking about the MMRS program, 120 cities are involved, not all of them have received training yet. Approximately 80 of the cities have been trained.


Ray Pena: How do we find out what labs are members of the National Lab Response Network?

Kim McCoy: We have a person in our labs that could provide that information or you can contact APHL directly.


Amy Sebring: How are private physicians integrated into the detection and surveillance aspect?

Kim McCoy: They are mostly being integrated at the state and local level. We work with state health departments and they in turn work with local and regional health officials. We are planning to do more work in that area particularly through our hospital infections program.


Tom Reitz: What size are the cities in MMRS and what do you recommend for cities under 50,000 in population?

Kim McCoy: First, I should clarify that MMRS is an OEP program so I don't have all the details of what kind of progress they have made and the specific activities that they are conducting. However, for smaller cities that want to enhance their public health preparedness, I suggest that they contact their state health department to become involved in the planning efforts that are happening at that level.


Isabel McCurdy: What is the MMRS Program?

Kim McCoy: Sorry, MMRS is Metropolitan Medical Response System.


Tom Quail: Thank you. I understand that Poison Control Centers will be observing real time exposure data with a program through CDC. Are you aware of this? And can you comment?

Kim McCoy: I am not aware of this but I do know that some state health departments are contracting with their regional poison control centers to access some of that data.


Amy Sebring: It sounds like you are coordinating primarily through state public health agencies. Do you find that state emergency management agencies are typically involved?

Kim McCoy: Yes, our cooperative agreement program is with the health departments that are our primary partners. However, many states have bioterrorism task forces that include a variety of state and local agencies and partners.


Mark DeMier: FYI: I host a Web site 'portal' of information related to these issues everyone may find useful at <http://www.homelanddefense.org>, and an online publication at <http://www.homelanddefense.org/journal/>.


Carl Fraker: Detection at or near the time of release is a real challenge --- have you heard of any breakthroughs on this side of the problem?

Kim McCoy: You're right, it is a huge challenge. We are constantly working to develop new techniques and methods for surveillance and detection of these types of events. I can't tell you about any specific solutions but I would be happy to put you in touch with our epidemiology staff if you would like more information about what they are doing.


Don Benedik: Are there agents that may affect crops? Where would we find information on this?

Kim McCoy: Yes, there are agents that could affect crops or livestock; this is an emerging area of bioterrorism preparedness. Some of the frontier states are doing some innovative work in this area and I'm sure they would be happy to share some of their information with you. Montana and Wyoming in particular are focusing on agricultural issues. USDA could also offer some assistance.


Scott Green: How would the medical supplies and medicines from the caches you mentioned get distributed during response to a WMD event?

Kim McCoy: Scott, there are 8 caches of materials located around the US. These caches would be delivered to the airstrip nearest the site of the incident and then be transferred to state personnel who would break down the caches and deliver them to the distribution sites. Each state is responsible for developing a plan for dissemination of the materials in the stockpile.


Amy Sebring: Kim, is the Health Alert Network fully implemented or still under development?

Kim McCoy: The Health Alert Network is in various stages of implementation. Currently 40 states and localities receive funding to establish HAN. They work with their local health departments to set up the hardware and software needed to implement the network. So it depends on the current capability of the localities as to how quickly they are able to get the system up and running.


Terry Storer: Do you feel that there will be a return to mass immunizations as a means to reduce bio threats?

Kim McCoy: Terry, that is not my area of expertise but I know that it hasn't been the focus of any discussions recently. I think its fairly unlikely but as we are constantly finding out bioterrorism issues change from day to day and depend greatly on information that comes to us from US intelligence agencies. For instance, if we hear that smallpox is becoming a greater threat, then plans could change rapidly.


Amy Sebring: Kim, perhaps you would like to mention the CDC Web site at this point?

Kim McCoy: If you need additional information, please feel free to contact me at 404-639-0387 or <[email protected]>. The Web site address is <http://www.bt.cdc.gov> .


Curt Mayfield: Any advanced technologies under consideration by CDC to improve surveillance and detection of bioagents?

Kim McCoy: We are currently working on a temporary surveillance system that can be implemented during special events such as the World Trade Organization conference, the Olympics, etc. There are also some plans in the works for improving data collection and reporting capabilities. Again, I would be happy to put you in touch with our epidemiology and surveillance staff for more information on aberration detection tools, syndromic surveillance methods and other activities that are in the works.


Isabel McCurdy: Is the Health Alert Network American-based only or are there plans to be partnered internationally?

Kim McCoy: Right now our focus is on enhancing domestic capacity so HAN has only been implemented in the U.S. However, there have been some discussions recently how to expand our program to address international concerns.


Amy Sebring: Does CDC host any national or regional conferences?

Kim McCoy: Yes. Our updated Web site is scheduled to go up tomorrow and will feature a list of upcoming events and conferences. Last year we hosted a series of regional conferences, and we are planning a national conference for 2002. However, bioterrorism issues are often incorporated into conferences on other subjects such as Emerging Infectious Diseases.

Final Question:

Tom Quail: Do you know what the progress is of the intra-net web site that is being developed? And what specific agencies will have access?

Kim McCoy: We are currently updating our public Web site to include more information about federal, state and local bioterrorism activities. We also have some secure Web sites on specific topics that are accessible to specific interest groups or agencies that we fund.


Amy Sebring: Thank you very much, Kim. We very much appreciate your time and effort. Please stand by a moment while we take care of some business.

We will have a text transcript posted later today, and reformatted versions at the end of the week.

If you are not on our mailing list and would like to receive weekly notices and our newsletter, please see <http://mail.wces.net:81/guest/RemoteListSummary/EIIP> to subscribe.

Next week we will have a Tech Arena session featuring Chemical Biological Response Aide (CoBRA), with Craig Levy, Deputy for Responder Services and Brad Gardner, Deputy for Product Development, Defense Group, Inc. Please join us then.

Thanks to all our participants today. We will adjourn the session for now and you no longer need to use question marks. Please help us express our appreciation to Kim for today's presentation.